8.13 Resource Flag - Content

Prospective warnings of potential issues when providing care to the patient.

8.13.1 Scope and Usage

A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involve in patient care. It usually represents
something of sufficient significance to warrant a special display of some sort - rather than just a note in the resource.
A flag has a subject representing the resource that will trigger its display. This subject can be of different types, as described in the examples below:

A note that a patient has an overdue account, which the provider may wish to discuss with them - in case of hardship for example (subject = Patient)

An outbreak of Ebola in a particular region (subject=Location) so that all patients from that region have a higher risk of having that condition

A particular provider is unavailable for referrals over a given period (subject = Practitioner)

A patient who is enrolled in a clinical trial (subject=Group)

Special guidance or caveats to be aware of when following a protocol (subject=PlanDefinition)

Warnings about using a drug in a formulary requires special approval (subject=Medication)

etc.

A flag is typically presented as a label in a prominent location in the record to notify the clinician of the potential issues,
though it may also appear in other contexts; e.g. notes applicable to a radiology technician, or to a clinician performing a home visit.
For patients, the information in the flag will often be derived from the record, and therefore, for a thorough and careful clinician, who has the time to review the
notes will be redundant.
However, given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this
redundancy is deemed appropriate. As well, some flags may reflect information not captured by any other resource in the record.
(E.g. "Patient has large dog at home")

In line with its purpose, a flag is concise, highlighting a small set of high-priority issues among the much larger set of
data in the chart. Readers who want more detail should consult the chart or other source of information. Caution should be exercised in creating Flag instances.
If entries are created for information that could be gleaned in a sufficiently timely fashion by reviewing the patient record,
the flag list will itself become overwhelming and will cease to serve its intended purpose.

Flags are expected to persist in a record for some period of time and are, at most, targeted to particular types of practitioners
or to practitioners in particular system.

Note that we include "latex allergy" in the "in scope" list, and "allergy" in the "not in scope" list. The Flag resource is not
designed to replace the normal order checking process, and one should not expect to see all allergies in Flags. However, if there
is an activity that might occur prior to careful evaluation of the record (e.g. donning of latex gloves) and that activity might
pose a risk to the patient, that is the sort of eventuality the Flag is intended to support.

Specific guidelines about what type of information is appropriate to expose using Flag, as well as what categories of individuals
should see particular flags, will vary by interoperability community.

8.13.2 Boundaries and Relationships

Flags may highlight a highly condensed view of information found in the AllergyIntolerance,
Condition, Observation, Procedure and possibly
other resources. A common extension allows the linkage of a Flag to the supporting detail resource.
The purpose of these other resources is to provide detailed clinical information. The purpose of a Flag is to alert practitioners to
information that is important to influence their interaction with a Patient prior to detailed review of the record.

Flags are not used to convey information to a specific individual or organization (e.g. an abnormal lab result reported to the ordering
clinician, reporting of an adverse reaction to a regulatory authority). These are handled using the
CommunicationRequest and the Communication resources.

Flags are not raised as a result of a reported or proposed action (e.g. drug-drug interactions, duplicate therapy warnings).
These would be handled using DetectedIssue.